Roundup: New Guidelines for Children’s Concussions and Use of Rear-Facing Car Seats

The U.S. Centers for Disease Control and Prevention (CDC) has released new recommendations for healthcare providers when treating children with mild traumatic brain injury (mTBI), most commonly referred to as a concussion.

The CDC’s guidelines are for concussions from all causes, including falls, sports and car accidents. They urge rest for the injured child from physical and mental activity, including school and sports programs, immediately after a concussion. The guidelines say there should be a gradual resumption of normal routines for the child based on individual diagnoses by his or her doctor.

“We have heard from healthcare providers that they want and need consistent, current, and evidence-based guidance for diagnosing and managing mTBI. And this guideline can help,” said Deb Houry, M.D., director of CDC’s National Center for Injury Prevention and Control. “However, we also designed the guideline so it can help inform efforts aimed at supporting families, sports coaches, and schools—who are all integral to keeping children safe and healthy.”

The new CDC guidelines, published this week in JAMA Pediatrics, are based on a “comprehensive review of the science on pediatric mTBI to date—covering 25 years of research,” the CDC states. The CDC recommend against routine X-rays. Most kids should fully recover within one to three months, the U.S. agency says.

Both theAmerican Academy of Neurology and the American Academy of Pediatrics have similar evidence-based guidelines, but are primarily for sports concussions in children and young adult athletes. They focus on managing sports concussions, and for returning to school after such an injury.

Here are the 5 primary CDC recommendations that were released this week:

Do not routinely image pediatric patients to diagnose mTBI.

Use validated, age-appropriate symptom scales to diagnose mTBI.

Assess for risk factors for prolonged recovery, including history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).

Provide patients and their parents/caregivers with instructions on returning to activity customized to their symptoms.

Counsel patients and their parents/caregivers to return gradually to non-sports activities after no more than a 2-3 days of rest.

Children Should Use Rear-Facing Car Seats ‘As Long As Possible,’ Pediatricians Now Say

The American Academy of Pediatrics (AAP) now recommend that children remain in a rear-facing car seat “as long as possible” until they reach the highest weight and height allowed by the manufacturer of the seat, according to a new policy statement “Child Passenger Safety” that will be published in the November issue of Pediatrics.

Previously, the AAP only recommended that children be kept rear-facing until the age 2.

“As all evidence continues to show the relative superiority of rear-facing, the Academy continues to recommend that all children ride in a rear-facing car safety seat as long as possible, up to the manufacturer’s stated weight and length limits,” states Benjamin Hoffman, M.D., co-author of the policy statement and chairman of the AAP Council on Injury, Violence and Poison Prevention.

Dr. Hoffman adds that no car seat manufacturer allows for any child under 12 months to ride forward-facing, and “several require all children under 2 years to ride rear-facing.”

The previous AAP recommendation that children be kept rear-facing until the age 2 was based partly on a study that found lower risks of injury among children ages 1 to 2 years who were rear-facing. But that data was supported by biometric research, crash simulation data and experience in Europe, where children ride rear-facing for longer periods, the AAP states.

Questions were raised in 2017 about the original study, and it was retracted by the journal Injury Prevention.

The AAP explains: “A re-analysis of the data found that while rear-facing still appeared to be safer than forward-facing for children younger than 2, the injury numbers were too low to reach statistical significance. The AAP decided to update its recommendations to reflect how the science has evolved.”

The AAP recommends that:

Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.

Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more.

When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.

When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.

All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.